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PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 401k Plan overview

Plan NamePRESBYTERIAN MANOR HEALTH BENEFIT PLAN
Plan identification number 502

PRESBYTERIAN MANOR HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PRESBYTERIAN MANOR, INC. has sponsored the creation of one or more 401k plans.

Company Name:PRESBYTERIAN MANOR, INC.
Employer identification number (EIN):751522727
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about PRESBYTERIAN MANOR, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1974-08-22
Company Identification Number: 350546
Legal Registered Office Address: *
Onondaga
SKANEATELESS
United States of America (USA)

More information about PRESBYTERIAN MANOR, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRESBYTERIAN MANOR HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-09-01
5022020-09-01
5022019-09-01
5022018-09-01
5022017-09-01KRIS AWTREY KRIS AWTREY2018-10-31
5022016-09-01W. JAMES OAKLEY W. JAMES OAKLEY2017-11-17
5022015-09-01W. JAMES OAKLEY W. JAMES OAKLEY2016-12-06
5022014-09-01W. JAMES OAKLEY W. JAMES OAKLEY2015-10-28
5022010-09-01W. JAMES OAKLEY W. JAMES OAKLEY2012-06-13

Plan Statistics for PRESBYTERIAN MANOR HEALTH BENEFIT PLAN

401k plan membership statisitcs for PRESBYTERIAN MANOR HEALTH BENEFIT PLAN

Measure Date Value
2021: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01116
Total number of active participants reported on line 7a of the Form 55002021-09-010
Total of all active and inactive participants2021-09-010
2020: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01119
Total number of active participants reported on line 7a of the Form 55002020-09-01116
Total of all active and inactive participants2020-09-01116
2019: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01117
Total number of active participants reported on line 7a of the Form 55002019-09-01119
Total of all active and inactive participants2019-09-01119
2018: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01122
Total number of active participants reported on line 7a of the Form 55002018-09-01117
Total of all active and inactive participants2018-09-01117
2017: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01119
Total number of active participants reported on line 7a of the Form 55002017-09-01122
Total of all active and inactive participants2017-09-01122
2016: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01114
Total number of active participants reported on line 7a of the Form 55002016-09-01119
Total of all active and inactive participants2016-09-01119
2015: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01104
Total number of active participants reported on line 7a of the Form 55002015-09-01114
Total of all active and inactive participants2015-09-01114
2014: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01109
Total number of active participants reported on line 7a of the Form 55002014-09-01104
Total of all active and inactive participants2014-09-01104
2010: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-01100
Total number of active participants reported on line 7a of the Form 55002010-09-0187
Total of all active and inactive participants2010-09-0187

Form 5500 Responses for PRESBYTERIAN MANOR HEALTH BENEFIT PLAN

2021: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01This submission is the final filingYes
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2010: PRESBYTERIAN MANOR HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01First time form 5500 has been submittedYes
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered0
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered131
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $47,806
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,030,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,806
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered144
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $46,305
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $928,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,305
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered146
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $46,318
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $911,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,318
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered145
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $43,241
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $850,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,241
Insurance broker organization code?3
Insurance broker nameMARK WELLS INSURANCE
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered131
Insurance policy start date2015-09-01
Insurance policy end date2016-08-31
Total amount of commissions paid to insurance brokerUSD $38,796
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $778,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,796
Insurance broker organization code?3
Insurance broker nameMARK WELLS INSURANCE
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number17412
Policy instance 1
Insurance contract or identification number17412
Number of Individuals Covered124
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $37,295
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $753,971
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,295
Insurance broker organization code?3
Insurance broker nameMARK WELLS INSURANCE
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number017412
Policy instance 1
Insurance contract or identification number017412
Number of Individuals Covered87
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $35,693
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $685,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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